Blessed Health Care Provider Inc
Organization Active NPI Home Health Agency · La Verne, CA
NPI 1770770554 · NPPES record last updated May 20, 2025
Key facts
- NPI
- 1770770554
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- BLESSED HEALTH CARE PROVIDER INC
- Practice address
- 1768 Arrow Hwy Ste 103
La Verne, CA 91750-5335 - Phone
- (626) 858-2319
- Fax
- (626) 858-8355
- NPI assigned
- Sep 26, 2007
- Organization subpart
- No
Authorized official
- Name
- Evelina Pineda
- Title
- President
- Phone
- (909) 392-8917
Affiliated clinicians 1
Medicare Care Compare: Home health agency
- Listed as
- Blessed Health Care Provider, Inc
- Ownership
- Proprietary
- Certified
- Apr 11, 2011
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D1070865 | Blessed Health Care Provider Inc | Certificate of waiver | Jul 10, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Home health agency certification: CCN 059298
- Legal name
- BLESSED HEALTH CARE PROVIDER INC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Apr 11, 2011
- Last certification
- Apr 21, 2021
- Ownership / control type
- Proprietary
- Organization structure
- Corporation · Proprietary
- Incorporated
- Apr 5, 2007 in CA
- Enrollment address
- 1768 Arrow Hwy
Ste 103
La Verne, CA 91750-5335
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Angelina M Cruz |
Corporate Director | Oct 23, 2007 | |
| W-2 Managing Employee | Oct 23, 2007 | ||
| Jocelyn D Rowe |
5% Or Greater Direct Ownership Interest | Oct 23, 2007 | |
| Corporate Director | Oct 23, 2007 | ||
| W-2 Managing Employee | Oct 23, 2007 | ||
| Emmanuel L Pineda |
Corporate Director | Oct 23, 2007 | |
| W-2 Managing Employee | Oct 23, 2007 | ||
| Evelina O Pineda |
5% Or Greater Direct Ownership Interest | Oct 23, 2007 | |
| Corporate Director | Oct 23, 2007 | ||
| W-2 Managing Employee | Oct 23, 2007 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071031000606 | CA | Part a Provider - Home Health Agency | 7012004450 | Practice locations: La Verne, CA |
National Provider Directory
Locations
271 E Workman St
Ste 201
Covina, CA 91723
Phone (626) 858-2319
1768 Arrow Hwy
Ste 103
La Verne, CA 91750
Phone (626) 858-2319
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
1768 Arrow Hwy Ste 103
La Verne, CA 91750-5335
Mailing address
1768 Arrow Hwy Ste 103
La Verne, CA 91750-5335
Phone (626) 858-2319
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05D1070865 | Other | CLIA CERT OF WAIVER |
Other providers in La Verne, CA
- Elijah Elias Bernal
- Krupa Bhakta
- Vipul Bhavani
- Elizabeth Ellen Blackstock
- Jamie Blanco
- Rebecca Bobadilla
- Joan Boothby
- Osama Boules
- Brian Craig Boyer
- Kenneth James Boyer
All providers in La Verne, CA · Home Health Agency in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.